The pathology of ophthalmoplegia / by W.J. Collins and L. Wilde.

  • Collins, William Job, 1859-1946.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: The pathology of ophthalmoplegia / by W.J. Collins and L. Wilde. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Eije affected. Of 109 cases, 1 eye only was affected in 61 cases, both eyes in 48. In the 61 cases in which only one eye was aflected, this was the right in 31, the left in 30; showing that the side affected is a matter of indifference. The above figures, of course, destroy the importance attached to the symmetry of the lesion. Our cases include many in which the affection was in the nerve-trunks, but in some of these the palsy was bilateral; and we think far too great importance has been attached to the question of symmetry as deciding the seat of the lesion. Distribution of the palsy as regards various portions of third nerve. Of the 120 cases of ophthalmoplegia in which the external ocular muscles were affected, there was evidence of some affection of intra-ocular mus- cles in 65. In 29 of the 65 both iris and ciliary muscle were involved. We would, however, direct especial attention to the mode of linking of extra ocular palsy with cycloplegia and indoplegia respectively as bearing upon the work of Hensen and Volker and of Kohler and Pick. In the 34 cases in which only one of the two (viz., iris or ciliary) was affected, plus extra-ocular palsy, in no less than 31 it was the iris and not the ciliary, and in only 3 was it the ciliary and not the iris. If it be true that the centres for ciliary, iris, and extra-ocular muscles are arranged in that order—tandem fashion—on the floor of the aqueduct, we can understand why the linking of the palsies should be as above. Distribution of palsy as regards nerves involved. Of the 116 cases in which the analysis could ,be made, in 47 the third nerve alone was aflected (in 18 complete, in 29 incomplete) ; in 42 the third, fourth, and sixth were affected in company; in 11 the sixth alone was affected ; in 8 the third and fourth failed together; in 4 the third and sixth are pre- sumed to have been associated in palsy ; in 2 the fourth and sixth, and in 2 the fourth alone. The frequent bracketing of the third, fourth, and sixth might suggest the frequency of lesion in the course of the nerve-trunks; but the rela- tive infrequency of attack of the sixth, in spite of its longer and more arduous extra-cerebral, intra-cranial course, would rather suggest an opposite reflection. The direct connections between the sixth nuclei and those of the third and fourth by the posterior horizontal fibres are to be borne in mind. Bemlt. Of the 92 cases out of the 120 in which the result is noted 53 improved under treatment, 26 completely recovering, and in 14 more the improvement was stated to be considerable; in 15 there was no im- provement, in 2 the disease was progressive, and in 22 it was fiital. Age and fatality. We have previously suggested that ophthalmoplegia of young children was probably more serious and fatal than that of adults. Of 6 cases under ten in which the result is recorded, 3 died, or 50 per cent.; of the 86 over ten in which the result is recorded, 19 died, or 23 per cent.